Hybrid endoscopic submucosal dissection enhances efficiency with comparable curative outcomes: a Bayesian meta-analysis, systematic review, and Monte Carlo simulation of randomized controlled trials

Abstract

Background/Aims: Gastrointestinal (GI) cancers accounted for 3.24 million deaths worldwide in 2022. Endoscopic submucosal dissection (ESD) enables en bloc resection of early neoplasms but is time-intensive and technically challenging. Hybrid ESD (H-ESD), which combines dissection with snare polypectomy, may improve efficiency while maintaining efficacy.This Bayesian meta-analysis of randomized controlled trials (RCTs) compares the safety and efficacy of H-ESD with conventional ESD (C-ESD). Methods: We searched the PubMed, Embase, Cochrane, Scopus databases for RCTs comparing hybrid and C-ESD for superficial GI neoplasms. Bayesian modeling in Just Another Gibbs Sampler used normal-normal hierarchies for procedure time and logRR for binary outcomes with weakly informative priors. Frequentist analyses were performed using Der-Simonian-Laird τ². Heterogeneity was assessed using I²/τ². Results: H-ESD showed comparable en bloc (RR, 0.97; 95% [CrI], 0.92-1.03; I²=22.8%) and R0 resection rates (RR, 0.97; 95% CrI, 0.90-1.04; I²=0%). Procedure time decreased significantly with H-ESD (MD, -18.05; 95% CrI, -27.77 to -8.33 minutes; I²=66.5%). Adverse events (RR, 1.08; 95% CrI, 0.44-2.63) and perforations (RR, 1.05; 95% CrI, 0.34-3.19) were similar between the two procedures. Conclusions: H-ESD matches C-ESD in curative resection while reducing the procedure time, offering a safer and more efficient alternative. Larger RCTs are needed to confirm the long-term benefits.